Diagnosis and Treatment of Ovarian Cysts

Ovarian cysts are swellings filled with fluid which form in the ovary. They can vary in size from less than one centimeter to greater than 10 centimeters. There can be one or more cysts on an ovary (unilateral) or there can be cysts on both ovaries (bilateral). Ovarian cysts can occur both before and after menopause, but they are most common in young women who are of childbearing age. In some cases, ovarian cysts prove to be harmless and not cancerous (benign). In other cases, however, they may become dangerous to a woman’s fertility or they may turn out to be malignant. Seeking diagnosis, treatment and consultation with a specialist is recommended.

Having ovarian cysts does not necessarily mean that you have ovarian cancer. Ovarian cysts are not the most common cause of ovarian cancer. Women who are most at risk of developing ovarian cancer are as follows:

• Women with a history of breast or gastrointestinal cancer
• Women with a family history of cancer, especially ovarian cancer
• Women with a complex ovarian cyst. A complex cyst is one with a nodule on the surface, one with solid areas, or one with many fluid-filled areas.
• Women whose imaging test results show ascites (a fluid collection) in the abdomen or pelvis.

Women without cancer can also fall into these categories. Further testing is recommended in order to diagnose the full extent of the patient’s condition.

Here the ways in which ovarian cysts can be found:

Pelvic Exam – A routine pelvic exam can help discover ovarian cysts. However, a pelvic exam cannot provide a definitive diagnosis. Other methods of diagnosis should also be pursued.

Vaginal sonogram – This imaging test is performed by inserting an instrument called a transducer into the vagina. A vaginal sonogram can help the doctor determine the size of the cyst and detect whether it is fluid-filled or solid. It can also verify the cyst’s shape and location. However, the sonogram is not able to determine whether the cyst is benign or malignant. Other methods of diagnosis should also be pursued.

Blood tests – The patient may also be given a blood test to check the amount of a protein called CA125, which can rise due to ovarian cancer. However, blood tests cannot provide a definitive diagnosis, especially since CA125 can rise due to other conditions, such as pelvic or abdominal infection, pregnancy, and hepatitis. Other methods of diagnosis should also be pursued.

Diagnostic Laparoscopy – A form of minimally invasive surgery (MIS), laparoscopic surgery uses a small camera (a laparoscope) to look inside the patient’s abdomen or pelvic organs. The procedure allows for the doctor to fully inspect and remove the cyst. With this new medical technique, the surgery can be done with smaller incisions, less pain and faster recovery. This is the method which provides the most definitive diagnosis of ovarian cysts. If surgical treatment is needed, the doctor can proceed with a laparoscopic ovarian cystectomy.

Women who have had their menopause and who have ovarian cysts are usually monitored by the doctor through routine CA125 testing and ultrasound scans. Most small cysts (less than 5 cm wide) usually disappear within 3 months, but an ultrasound scan every 4 months afterwards is recommended.

Many ovarian cysts disappear on their own.  At first, the doctor might want to wait and observe the patient’s condition. Premenopausal patients are first monitored for symptoms. Then, a pelvic ultrasound is performed again after six to eight weeks. Surgery is not usually required if the cyst does not enlarge or if it resolves itself. Postmenopausal patients might have to undergo an ultrasound and a CA125 test every three to six months.

Treatment is required if the cyst does the resolve and poses the threat of cancer. A benign cyst should be removed when the size is as large as 4-5 cm. The state of the cyst factors in as well, are there complications? Does it seem near rupture?

A form of minimally invasive surgery (MIS), laparoscopic surgery uses a small camera (a laparoscope) to look inside the patient’s abdomen or pelvic organs. The procedure allows for the doctor to perform a biopsy and remove the cyst. This surgery can be done with smaller incisions, less pain and faster recovery.

Here are three types of laparoscopic surgeries which have been developed throughout the years

• Conventional laparoscopy – requires two to four tiny incisions on the abdomen.
• Single-port laparoscopy – requires special tools and surgeons with expertise. Unlike conventional laparoscopy, the surgery leaves only one scar on the navel. Once the wound from the incision heals, the scar will be rolled and concealed by the belly button, making it no longer visible.  
• Laparoscopy using the NOTES technique – requires surgeons with particular expertise and is a procedure which proves less painful than other kinds of laparoscopy. NOTES, or natural orifice transluminal endoscopic surgery, is performed through the birth canal and leaves no scars on the skin. Learn more about NOTES technique and its benefits by clicking here. 

There is no need for further imaging tests if the patient’s ovarian cyst is resolved or removed successfully. Endometriomas and functional ovarian cysts are a few examples of cysts which are more likely to recur. The doctor can recommend taking birth control pills or other forms of hormonal therapy should the patient be concerned about recurrent cysts.

References

1. Ovarian Cysts. Available from https://www.acog.org/-/media/For-Patients/faq075.pdf?dmc=1&ts=20160715T0457458092. Accessed on July 20, 2016.
2. Ovarian Cysts. Available from http://www.hopkinsmedicine.org/gynecology_obstetrics/specialty_areas/gynecological_services/conditions/ovarian_cysts.html. Accessed on July 20, 2016.
3. Can ovarian cysts become cancerous?. Available from http://www.cancerresearchuk.org/about-cancer/cancers-in-general/cancer-questions/can-ovarian-cysts-become-cancerous. Accessed on July 20, 2016
4. Ovarian Cysts: Beyond the basics. Available from http://www.uptodate.com/contents/ovarian-cysts-beyond-the-basics. Accessed on July 20, 2016